Dáil Éireann díospóireacht -
Thursday, 17 Feb 1994

Vol. 439 No. 1

Supplementary Estimates, 1994. - Stillbirths Registration Bill, 1994 [Seanad]: Second Stage.

Minister for Equality and Law Reform (Mr. Taylor)

I move: "That the Bill be now read a Second Time."

The purpose of this Bill is to provide for offical registration of stillbirths. There are more than 300 stillbirths each year in Ireland, or about six in every 1,000 births. A stillbirth can have a very powerful impact on the lives of the parents involved. It is an event which can create great loneliness and shock. There is ample testimony of the trauma and sense of loss which parents can experience following a stillbirth. In some cases, parents can experience long term suffering as a result of the stillbirth.

One of the significant developments in psychology in recent years has been recognition of the need to grieve as part of the healing process. Research evidence is accumulating which concludes that an important facet of the process of coming to terms with, or adapting to, any loss involves recognition and acknowledgement of the person who has died. This acknowledgement facilitates appropriate grieving after the loss. It is associated with more positive adaptation to the loss and far better long term psychological outcomes.

The parents of stillborn children here receive no official recognition of the existence of their stillborn child. There is some form of civil registration of stillbirths in most, if not all, other European Union countries. In Ireland, there have been calls from many quarters for the establishment of a stillbirths register. Bereaved parents, and in particular the Irish Stillbirth and Neonatal Death Society, ISANDS, has been campaigning on this issue for some time. The Second Commission on the Status of Women also recommended that a stillbirths register be established.

The establishment of a stillbirths register, as proposed in the Bill, will not only bring this country into line with other European Union countries but, more importantly, will provide tangible evidence for parents of the existence of their stillborn child. The register will thus serve as a focus for the memories of bereaved parents and help them to come to terms with their loss.

My approach to this Bill has been shaped by two considerations. On the one hand, the rationale for stillbirths registration is essentially therapeutic. Stillbirths registration is primarily intended to comfort grieving parents rather than to serve an evidential or statistical purpose. Statistics on stillbirths are already compiled by the Central Statistics Office and by the Department of Health. Given its therapeutic rationale, the stillbirths registration system should not be unduly bureaucratic or impose additional burdens on bereaved parents. On the other hand, if an official register is to be created, some procedural formality is necessary to ensure the accuracy of the information recorded. The Bill aims to combine sensitivity to the needs of bereaved parents with the formality appropriate to a part of the civil registration system.

I have given considerable thought to the definition of a stillbirth to be included in the Bill. A stillborn child is a child born dead but viable outside the womb. There is, however, no universally accepted medical definition of what constitutes viability. In some countries the demarcation between a miscarriage and a stillbirth is based on gestational age. The gestational age used was typically 28 weeks, but because of advances in medical care this has been reducing. Twenty-four weeks is now the threshold for stillbirths registration in the UK. Other countries base their definition on the weight of the child, 500 grammes being the normal weight used.

A case can be made for either criterion. Weight is regarded as more definitive than gestational age, which can be difficult to assess. Weight is also the World Health Organisation's preferred criterion. On the other hand, gestational age reflects parents' expectations about the outcome of pregnancy more accurately than weight, which is typically unknown. My view is that since the main reason for establishing a register is to comfort grieving parents, the definition of a stillbirth in the Bill should be as wide as possible, consistent with accepted medical norms. I have therefore provided in section 1 that the Bill will apply to a child which is born dead and which either weighs a minimum of 500 grammes or has a minimum gestational age of 24 weeks.

I would emphasise that the Bill is about registration of stillbirths and that the registration of miscarriages is not within its scope. There is an acknowledged difference between a stillbirth, which is a child born dead but viable outside the womb, and a miscarriage, where the pregnancy ends before viability is reached. The registration systems in other European Union countries draw a line between a stillbirth, which is registrable, and a miscarriage, which is not. While I recognise that a miscarriage can be a source of distress and disappointment to the parents involved, this Bill is dealing with the question of stillbirths registration.

Section 3 of the Bill provides for the registration of stillbirths within the existing organisational framework for registration of births, deaths and marriages. In other words, responsibility for the registration of stillbirths would be assumed by the Registrar-General, superintendent-registrars and the 300 local registrars. A stillbirth will therefore be registered at local level as is a birth or death.

As the stillbirths register is an official one and as certificates will be provided to parents, it is important the information held on the register be accurate. I have therefore provided in section 5 that where the parents of the stillborn child are not married to each other, the procedural formalities for recording the father's name on the register will be the same as for a live birth. These procedures are set out in section 7 of the Births and Deaths Registration Act (Ireland), 1880, as amended by section 49 of the Status of Children Act, 1987.

Section 6 of the Bill provides that registration will be compulsory in the case of stillbirths which occur on or after the commencement of this Bill. Compulsory registration of stillbirths is the norm in other jurisdictions. By making registration compulsory I believe that we assert the offical character and status of the register and thereby reinforce the reality of the stillborn child, particularly as perceived from the parents' point of view. I recognise, however, that it would not be appropriate to add to the grief of the parents by imposing a duty on them to inform the registrar of a stillbirth or by pursuing them for failure to do so. Section 6 provides an option for the parents to inform the registrar of the stillbirth if they wish. If the parents do not choose to inform the local registrar themselves within a specified period, then the duty to inform the registrar will fall to the relevant hospital or, where no hospital is involved, to the relevant medical practitioner. This procedure will ensure that registration is comprehensive.

I am also making provision, in section 7, for retrospective registration of stillbirths. A stillbirth which occurred at any time before the commencement of the Bill may be registered at the request of either parent and subject to the production of satisfactory supporting documentation. This degree of retrospection is unusual in legislation but I am conscious of the fact that the suffering of bereaved parents of stillborn children can last for a long time, even for decades. In the absence of retrospection this Bill would come too late for many people. I believe that a compassionate approach requires that we facilitate those who want official recognition of past stillbirths. Such retrospective registration will, of course, be entirely voluntary as it would be neither practical nor desirable to make registration of past stillbirths compulsory.

Section 8 deals with stillbirths registers. Information held on these registers will not be accessible to the public. This differs from the position in relation to birth and death certificates, where any member of the public is entitled to search indexes of registers and is entitled to obtain any certificate simply by paying the required fee. In the case of stillbirths no public interest would be served by having the information on the registers open to the public and, given the relatively small number of stillbirths each year, an openly accessible register could be seen as an invasion of the privacy of the person concerned. The registers of stillbirths here, like those in the UK and Northern Ireland, will be private.

A certificate of a stillbirth will be available to the parents of the stillborn child, either at registration, if the parents choose to notify the registrar themselves, or subsequently, subject to verification of the parents' identity. Stillbirth certificates will otherwise be made available only at the discretion of the Registrar-General. The fee will be the same as for a birth certificate. The format of the stillbirth certificate, which is detailed in the Schedule to the Bill, will resemble that of a birth certificate but will include information on the weight and gestational age of the the child together with information on both the mother's and the father's occupation and other personal details in line with the recommendations of the Second Commission on the Status of Women. This format will be the same for all stillbirths regardless of when they occurred.

I hope that this Bill will be received positively in the House. The campaign for a register of stillbirths has been in train for some considerable time. I am very pleased to be able to introduce this measure and I look forward to constructive contributions to the debate.

Mr. Bradford

The Minister concluded his remarks by saying that he hopes this Bill will be received positively in the House. I am sure that will be the case. When the Bill was debated in the Seanad the Minister's proposals were warmly welcomed by all parties. I wish to be associated with the comments made in the Seanad, where the Minister was complimented on introducing this important legislation. For ten years or so groups such as ISANDS — the Irish Stillbirth and Neonatal Death Society — have been lobbying to have legislation introduced.

I commend the Minister for stating that retrospective registration will not be compulsory under the legislation. This will be welcomed by many hundreds of people throughout the country and the Minister deserves our praise for it.

It is disappointing that it has taken so long to bring this legislation before the House. While it is a case of better late than never, it would make one wonder about the speed of reaction of the Oireachtas to problems in society. There has been a welcome response at Oireachtas level to demands for progressive social legislation. I hope the generous response the Minister got in the Seanad and which he will get here today will encourage him to bring forward further progressive legislation in the social field.

We must first pay tribute to those people in the Irish Stillbirth and Neonatal Death Society. In the past decade they have lobbied Government Departments and every Oireachtas Member, making their heartfelt pleas by way of personal representations and by letter. They have been successful and are to be commended for their efforts.

The Minister has stressed that the Bill is therapeutic rather than statistical. I welcome his giving parents the option of either registering the birth themselves or leaving the task to the hospital authorities. Medical professionals and psychologists are agreed on the importance of grieving over the death of a person of any age, including that of a child who is stillborn. This proposed register is one of the many ways in which the grieving process can be helped. We in this House must not underestimate the importance to parents of having a birth certificate and a death certificate for their child in the months and years following a stillbirth, particularly at the anniversary of the birth each year. Recognition by the State that they had a real child is most important for the parents and the brothers and sisters of a stillborn child. This is one aspect of the grieving process. It is disappointing that this measure, introduced almost 40 years ago in the UK. is only now being introduced here, but it is better late than never.

It is appropriate to mention the progress made in maternity hospitals to help parents come to terms with the loss of a child. I congratulate hospital personnel who have been the leaders in that process. The State has been a little tardy but medical personnel have not. It has been common practice for quite some time to facilitate parents who wish to hold the remains of their baby, to have the child photographed and keep the identity bracelet and, indeed, to have a postmortem carried out to discover the cause of death. At Oireachtas level we are finally responding.

We are often critical of the churches and of their views in particular fields of social legislation. In this area the churches, particularly the Catholic Church, have made great progress. The days are long gone when stillborn children were refused baptism and a place in consecrated graveyards. Nowadays funeral services are arranged and hospital chaplains have greatly assisted not just the parents but the hospital personnel in progressing these matters. In a sense this Bill is a tool for helping the hospitals and the churches to console and help parents and others who are bereaved.

There is some difficulty about the definition. However, the Minister is being as generous as he can in extending the definition rather than restricting it. No matter what limit is provided for, there will always be the hard case that is slightly under the limit. That is something we will discuss in more detail on Committee Stage. I would find it difficult to improve on what the Minister has provided here and I take the points he has already made in the Seanad. I would stress, however, that improvements in medical science and technology mean that a child at 24 weeks gestation can be viable. There will be ongoing medical improvements in this area and I presume that as a result of those improvements the Minister will keep in mind the possibility of changing the definition. I understand that the World Health Organisation is considering the possibility of stating a 450 gramme limit for a viable child. Perhaps that is something we can debate further on Committee Stage.

It is important to have a register of stillbirths for international comparison of statistics which will help medical researchers to make progress in determining the causes of stillbirths. The main reason for the Bill is therapeutic, but the statistical angle is important. Anything we can do to reduce the number of grieving parents in the future must be welcomed as progress.

We are informed that the rate of stillbirths among unemployed people and among the more disadvantaged in our society is much higher than the rate among the professional and salaried groups. We must ask ourselves why. We must look at it from a socio-economic point of view and see what we can do to improve the situation. With a figure of almost 18 per cent at one end of the socio-economic spectrum and 5 per cent at the other end questions must be asked and solutions found.

Recent findings show that of 319 girls in the Dundalk area who attended St. Vincent's secondary school in the fifties, five had stillbirths later in life and, even more alarmingly, 161 had miscarriages. The implications of this report are that many of these stillbirths and miscarriages were caused by radiation from the Sellafield nuclear reprocessing plant. We cannot make any judgment on that allegation but it points to the necessity for proper statistics that could be used in making a case where we feel health and safety are at risk. Although it is outside the scope of this Bill, I hope that in the future we will see this Minister bringing forward proposals for the registration of miscarriages and an examination of the causes of both miscarriages and stillbirths.

I expect that the compassion which prompted the bringing forward of this legislation and which will ensure that it will be passed unanimously by the House will also cause us to look in more detail at the miscarriage figures and set up some kind of registration system in that regard.

The provisions in the Schedule to the Bill are a significant step forward in that they provide for the inclusion of the mother's forename, surname, maiden name, where applicable, and occupation. At present the requirements for a typical birth certificate simply seek statistics in relation to the father's name, occupation and so on. Hopefully, this reaffirmation of the equality of the mother will be repeated in other areas. The proposed register is a significant improvement on the more established registers of births and deaths and I hope, in the context of the current review of the system of registration, that anomaly will be rectified.

I commend the Minister for accepting the recommendations of the Second Commission on the Status of Women in regard to a register of stillbirths and I ask him to campaign at Cabinet level for additional funding to provide adequate care for mothers of stillborn babies. I am sure nobody would contest the seriousness of the trauma suffered by such mothers. Additional funding is necessary for counselling and I hope the Minister will succeed in convincing his Cabinet colleagues of the need in that regard. It is important that sufficient funding for counselling purposes is available in maternity hospitals and at local health centres. In most cases, ongoing counselling is essential and that can be provided only if the necessary funding is in place. I know the Minister will endeavour to make progress in that regard.

From time to time we hear traumatic stories of mothers of stillborn babies being subjected to the torture of having to remain in a ward with mothers of healthy, newborn babies. That is a difficult position for the mothers of stillborn babies and the only way to improve that position is to ensure that sufficient funding is available for allocating private rooms in maternity hospitals to all mothers of stillborn children, regardless of means. The VHI or private wealth should not be taken into account in that regard. We should send out a message from this House this morning that all mothers of stillborn babies should have access to private rooms in maternity hospitals.

I welcome the Bill and my party support it. On Committee Stage we will examine the details. I congratulate the Minister on introducing this long awaited legislation.

Miss Quill

This a rare day in Irish political life, an occasion when politicians of opposing parties put aside their cut and thrust, put up their swords, turn their backs on the hurly burly frequently a feature of this House and combine to put their weight behind this welcome legislation. In so doing we are giving recognition to the role the State can play in helping in some way to confront one of the great mysteries of life, namely, the matter of stillbirth.

This legislation is very welcome. Its introduction was long sought by members of the Irish Stillbirth and Neonatal Death Society. For ten years members of that society battled bravely for its introduction. Their campaign was both courageous and coherent and touched not alone the heads, but the hearts, of all those they lobbied. Their memorial quilt, a patchwork of poignant memories put together by grief -stricken parents, was a most eloquent plank in their argument. It was a living testimony to the desire of parents to put in place their form of offical register in the absence of an official State register. That was eloquent proof that parents of stillborn babies wanted them to be accorded a status and not forgotten. It is important that such parents keep the memory of their children alive in their hearts and in the hearts of members of their families. That was an impressive statement by the parents of stillborn babies.

The campaign involved both women and men, and correctly so. It is wrong to assume that only mothers suffer in the case of a stillbirth. It is inevitable that mothers who have borne and nurtured the child suffer most, but fathers and other family members also suffer and we should not lose sight of that fact. While men were involved in the campaign, women were the major driving force behind it.

In the course of the campaign those people pointed challengingly to the fact that in Great Britain a register of stillbirths has been in existence for approximately 40 years and in Northern Ireland there has been a similar register for approximately 30 years. This is one of the last countries in the EU in which a register of stillbirths remains to be put in place. People made compelling arguments but failed to get results until the legislation before us today was drafted. Fulsome tribute is due to the Minister for his generosity in initiating this Bill in the Seanad and bringing it into this House today. On behalf of the Progressive Democrats I congratulate him. He is approximately one year in office and has introduced a number of things in that time, but if anything stands out as a testimony to his sense of humanity, it will be the speed with which he confronted the introduction of this Bill. I also want to acknowledge the part played by the Council for the Status of Women in supporting the campaign spearheaded by ISANDS. I note with satisfaction that many of the council's recommendations are incorporated in this legislation and, accordingly, it is much better legislation.

This is a sensitive and caring legislative measure. Its enactment will be an enormous source of comfort and consolation to bereaved parents. Meeting that requirement is the main motivation behind the legislation and in the course of introducing it in the Seanad the Minister stated that, in essence the legislation would have a major therapeutic effect and he acknowledged that as significant in its own right. However, the benefits of the legislation will go far beyond that single, though crucial, concern. The proposed register will be of considerable importance to the medical profession because it will provide accurate and detailed statistics which were not always available in the past. Moreover, it will encourage further research into the cause of stillbirth and miscarriage. That is something from which only good can flow in the future.

It is almost impossible for those of us who have been fortunate enough to escape the experience of stillbirth to appreciate fully the anguish and desolation of a parent when a pregnancy ends in a stillbirth. A dream is shattered, a hope unrealised and potential life is cruelly quenched. It is hard for people to come to terms with that. I described it earlier as a mystery. Death is the antithesis of life. It is a cruel irony when the anticipated experience of birth is finally cut off. Inevitably that experience leaves a deep scar. It is one of the most difficult situations with which people may be confronted. Death is never easy. Despite the grief we experience, we are culturally conditioned to accept the deaths of older people and of our parents. However, our culture does not condition us to accept the death of young life so cruelly and poignantly cut short.

Psychologists will confirm that the register proposed in the Bill will go some way towards helping people cope with the grief and to come to terms with the tragedy. It is important that at last politicians have recognised that position. There is no point condemning the failures of the past. Today we must rejoice in the achievement of the present and that the register is about to be put in place.

This Bill has received not only all party support but a generous response from the public. The issue has already been debated in the Seanad and a number of amendments which I considered tabling were fully debated in the Seanad. Some ideas, particularly those put forward by Senator Henry, who has a higher level of medical experience and expertise than the lay person, were taken on board by the Minister. Therefore, there is no merit in tabling further amendments and prolonging the debate. The Bill should be passed and enacted as quickly as possible and the machinery put in place in respect of the registration centres.

Regarding section 1, I am sure the Minister has given much thought and time to defining what is meant by a viable child eligible for registration. The final decision is a good one, which I support. As Deputy Bradford said, medical science is now advancing at a greater rate. This legislation can be amended if at some time in the future new insights emerge as to a different understanding in terms of weight or gestation period. However, the Minister has struck the right balance in regard to the definition of what constitutes viability in the light of current insights, medical understanding, the experience of other countries and the World Health Organisation.

Regarding section 3, the Minister's decision to give the provisions of the Bill a retrospective effect is praiseworthy. Seldom if ever are provisions in respect of new legislation given retrospective effect. I welcome that measure. It is important that parents who have suffered the experience of stillbirth in the past will be given the option to register the deaths of their children. People who battled long and hard to bring this about can now benefit. Parents who suffered from the trauma of stillbirths in the past can benefit from this provision as well as future parents. That provision is an enlightened one. The manner in which the details of the registration process have been set out is also welcome. The procedure is similar to the existing provision for registration of children who live after birth. That provision will help meet the emotional and psychological needs of parents who suffer the trauma of stillbirth.

As a result of this legislation and the discussion it has generated both in this House and the Upper House, there is an enhanced awareness among public representatives of the difficulties with which parents confronted with this mystery have to cope. There must be a renewed commitment to provide funding for proper counselling for parents who have to cope with stillbirths.

Deputy Bradford said that maternity hospitals have improved greatly in recent times in this regard. All maternity hospitals adopt a most compassionate and open approach to this issue, which is an advance on the attitude which prevailed up to ten years ago. There is a grave need for a follow-through counselling service. The situation is not resolved while the mother is in the hospital; that grieving period is just the start of parents coming to terms with the tragedy and the impact of the sense of loss. That grieving process continues for a long time. Mothers, parents and families need counselling specifically targeted at this area for a long time after the tragedy. It is important that such counselling, funded by the State, be provided. When counselling services are provided the objectives of the Bill will be met.

My party is not tabling any amendments to the Bill. We agree with its provisions. If new insights emerge in future years or faults are found in the procedures, the Bill can be amended as appropriate. However, the Bill as it stands is a good one and it meets all the requirements. I look forward to its speedy passage through the House.

Ms McManus

Democratic Left welcomes the publication of the Stillbirths Registration Bill. The desire of parents of stillbirths to have a legal record of the birth of their child is one that has been long felt. However, it is only relatively recently that we as a society acknowledged not just that desire but the pain and suffering stillbirth brings. I would like to pay tribute to ISANDS for its tenacity and dedication over the years in raising our consciousness in this regard.

In the past failure to understand the experience of having a stillbirth led to great misunderstanding and unhappiness. Hospital policy was very restrictive in the case of stillbirth. The sense of loss, particularly for the mother, in many cases was not officially or unofficially acknowledged. In recent years, because of a growing awareness, the position has changed and nowadays hospitals provide much greater understanding and flexibility. It is now the norm to provide a photograph. It is also possible for a mother to hold her baby after if has been born dead, and counselling is available. These factors help in a bereavement. Under this Bill parents are provided with formal recognition of the experience that they have gone through. The registration of stillbirths is official acknowledgment that these births have taken place and that for the individual family they have deep and long-lasting significance.

It should be remembered that one in four potential births end in miscarriage. We know that miscarriages can cause much grieving. A stillbirth, because of its very nature, deepens that loss. It is worth noting that many women and men know the grief of losing a potential child. I welcome the reduction of the length of gestation to 24 weeks or 500 grammes weight. The approach outlined in this Bill is the correct one. It provides an option for parents to notify the local registar of the stillbirth, but it places a duty on a hospital or relevant medical practitioner to notify the local registrar.

I also welcome the fact that the Bill allows for retrospective registration. I have met many parents who, years after their stillbirth, wish to have an official record of the experience. Many mothers in particular have said they wished to be able to have an official certificate which in itself would help to ameliorate their sense of loss. Some have even made the point that an official record of the registration of a stillbirth brings home to children of the family what has happened and makes the event more comprehensible.

One of the most significant features has been the consistent decline in the numbers of stillbirths in Ireland, along with neonatal and perinatal mortality. However, it is worth noting that the perinatal mortality rate is still the third highest in Europe after Portugal and Greece, and the reasons for this need to be understood. Much media coverage was given to a recent report which stated that Ireland is the safest place in the world to have a baby. However, the perinatal mortality rate in Ireland is one that we must take very seriously as it is very high.

At a time when the Irish birth rate is dropping so dramatically we need to look at the causes of perinatal mortality to find ways of reducing its rate as far as is possible. The factors determining the level of perinatal mortality include birth rate, parity, mother's age, poverty, and type of antenatal care, as well as many other variables. The most significant factor is that of class and social status. The rate of stillbirths is significantly higher among families where the father is unemployed than where the father has a professional occupation, is an employer or a salaried employee. The figures show that the stillbirth rate for 1990 was 14.9 per cent — only 3.5 per cent among higher professionals and 1.4 per cent among lower professionals. This is a huge disparity and is a clear statement of how socio-economic factors impinge on the health and welfare of our people.

The right to life has been promoted by many groups and organisations. However, one of the simplest ways to ensure the right to life in many cases would be to narrow the gap between rich and poor, to create jobs and to combat poverty and deprivation in our communities. Quality in health has more to do with socio-economic factors than it has to do with medical treatment. This applies not only to stillbirths but right across the board in many of the killer diseases, whether they be cardiovascular disease, lung cancer, suicide or respiratory diseases.

Class is a major element in health, yet this is something that has not been faced up to in health policy in the past. In our publication of a national health strategy, Democratic Left has made a strong case to the Minister for Health to put the issue of equality central in his national health strategy: If he does so, the strategy that he adopts will have the greatest chance of success. By focusing on those most at risk he would be increasing the general welfare and health of the nation at large. In the same way if perinatal health policy is focused on those at risk of a higher rate of stillbirth, that is those affected by unemployment, we would have the best chance of increasing our rate of live births and reducing our perinatal mortality rate, including stillbirths.

The Minister has stated that there are 300 stillbirths each year. In his Bill there is an implicit presumption that all these take place in hospital or with the attendance of a medical practitioner. However, he has neglected to include the small number of home births that occur in Ireland every year. Last year there were 200 home births, and this kind of domicilliary care is normally the responsibility of midwives rather than medical practitioners who have got out of the business of home deliveries. Midwives carry responsibility to notify a senior medical officer of a stillbirth, but there is no obligation on them in this Bill and that must be redressed.

This Bill offers us an opportunity to extend the information collected in a stillbirths register. I note that the Minister in his Seanad speech and again today made the point that the rationale for registration is essentially therapeutic and that a stillbirth registration is primarily intended to comfort grieving parents rather than to serve as an evidential or statistical purpose. While I fully recognise the value of registration for parents, it would be a pity if the Minister did not use the opportunity to provide statistical information that would be useful in health policy and planning information which could help to reduce the numbers of stillbirths, and also provide information on birth defects which would be immensely useful.

The provision of a birth defects register would give an overview as to the extent of birth defects and any geographic preponderance that they might display. For example, in the town of Arklow, a study has been carried out by local people to assess the level of birth defects, and the information, which is compiled on a voluntary basis, shows a preponderance of birth defects which is a matter of concern.

The fact that statistical information is not available on a national scale to assess the rate of birth defects and where they are located is something that should be addressed and is a matter of public health policy. Very little statistical research generally is carried out in Ireland and statistical collation of information creates major problems for devising health policy. This is a deficiency that can be at least partially addressed in this Bill if the Minister were to accept its value as a statistical gathering tool and extend it to the provision of a birth defects register.

At present we are participating in a study of congenital malformation, a study which has been ongoing since 1980, but it relates only to the cities of Galway and Dublin. We need a national register to ensure that we know the precise position with regard to birth defects nationally. In my own county of Wicklow there appears to be a number of children with hand defects; other cases have arisen in other parts of Ireland and in Britain. This has resulted in an analysis by the London Office of Population Censuses and Surveys of the records to see if there is cause for concern. Surely we in Ireland should carry out an investigation also. I appreciate that this is a matter for the Minister for Health, but a stillbirths register is an opportunity to at least look at a narrow cohort where birth defects occur, that is in stillbirths. This registration Bill offers an opportunity to provide that information. At the moment, families in Arklow and other towns in Ireland do not know if what they have experienced is part of a normal phenomenon or whether it has specific causes that need to be addressed.

There have been other matters of concern, particularly in south Wicklow and in County Louth relating to a high incidence of cancer. In County Louth, Dr. Patricia Sheehan carried out a study in relation to birth defects and stillbirths. She raised the question of whether there are environmental factors in relation to these cases. All mothers in the study of the St. Louis secondary school suffered severe influenza at the same time as the nuclear reactor in Windscale went on fire, sending out a cloud of radiation across the Irish Sea. At a time when BNFL are planning to proceed with the THORP development, we should not miss any opportunity to garner information that may be revealing and may point to the impact or otherwise of Sellafield on those living on the east coast of Ireland.

There is a study underway at the Boyne Research Institute in Drogheda on the incidence of miscarriages, stillbirths and birth defects along the north-east coast. It surely would be advisable for a stillbirths register to be linked with the Department of Health to provide information on the rate of stillbirths and the numbers of birth defects.

All of us live in the shadow of Sellafield and unless significant action is taken by the Irish Government we will all soon be living in the shadow of THORP. It is not a prospect about which Irish people are either confident or happy. The question marks over the impact of Sellafield on the health of our people will continue unless clear evidence is found that Sellafield is safe.

It is unfortunate that this Bill has been presented by the Minister for Equality and Law Reform, which puts a different emphasis on its importance. If it had been presented by the Minister for Health I believe the emphasis would have been put on the provision of hard medical research which would be of value not just to the parents of stillborn children but also to future parents and future children who might be protected from the possible environmental effects of radiation or other environmental factors about which we are unaware.

I welcome the Bill, which will meet the deeply held desire of many women and men to have their stillborn children registered. However, its potential for good will not be fully realised unless it is expanded to provide information and evidence which will enlighten public health policy. Stillbirth is a tragic fact. There will always be stillbirths, but there are also clearly preventable causes of stillbirth which should not always be with us. There is a certain irony in the fact that, at a time when the most extraordinary experiments are being carried out in reproduction and when women well over the age of menopause are giving birth, unemployed families in Ireland are still experiencing a far higher rate of stillbirths than better off families. The question of social class is a major determinant in the level of stillbirths and perinatal mortality. Environmental factors may also be major factors — we simply do not know. However, we know about the relevance of class and unemployment on this issue. I hope the Minister will take on board my Committee Stage amendments which deal with home births, statistical information and birth defects and which would add to what is a very limited pool of research and statistical information on health.

My final point relates to social welfare. At present maternity benefit is paid to women who have delivered a baby at a minimum of 28 weeks gestation. This payment is made whether the baby is dead or alive. In view of the fact that the Bill specifies that a baby born at 24 weeks gestation or weighing 500 grammes, is defined as a stillbirth and not simply a miscarriage, I suggest it would be appropriate to alter the regulations governing social welfare payments to ensure consistency. I do not think one Department can recognise that stillbirths occur at 24 weeks while the Department of Social Welfare applies different rules, does not recognise stillbirths and does not deem the mother to be eligible for maternity benefit. If it is acknowledged in law, through this Bill, that a stillbirth can occur from 24 weeks onwards, surely it makes no sense to deny a woman who delivers a dead child at 24 weeks the right to maternity benefit.

I have put down some minor Committee Stage amendments which would considerably improve the Bill and deal with one particular anomaly in it. Overall, Democratic Left welcomes this Bill which is an important breakthrough for all parents of stillborn children, particularly those in ISANDS who have fought so long and so consistently for recognition in this way.

Mr. Martin

I welcome this Bill. I join with other speakers in paying tribute to the members of the Irish Stillbirth and Neonatal Death Society. This is an historic and joyful day for them in the sense that their years of campaigning have at long last borne fruit. Deputy Quill referred to the patchwork memorial quilt put together by the parents of stillborn children. These parents managed to get their message across to public representatives in a non-controversial but very effective way.

Last year in my capacity as Lord Mayor of the city of Cork I was very touched to have been invited to officiate at a number of memorial services both at St. Finbar's Cemetery and St. Catherine's Cemetery, Kilcully. One could only be struck at those services by the depth of feeling and sincerity of the members of ISANDS and by the sense of loss felt by parents whose children have been stillborn. More than letters or any other correspondence, those services brought home to me the absolute necessity for the Legislature to respond to a genuine need in society. I stongly support the emphasis placed by the Minister on the therapeutic rather than the statistical dimension of the Bill.

The introduction of this legislation proves that the appointment of programme managers by the Government has been a success. The programme managers in both the Department of Health and the Department of Equality and Law Reform have had a major role to play. This is one of the best illustrations so far of the success of the programme managers concept. Their appointment received much adverse publicity and criticism but it must be remembered that until then the only official response to the parents of stillborn children was that they must wait until an overall reform of the death register was carried out before their request for a stillbirths register could be considered. It was not until I approached the programme manager in the Department of Health and other people approached the programme manager in the Department of Equality and Law Reform that any efforts were made to establish a stillbirths register. They acted as catalysts and facilitators and ensured that this matter was dealt with in a non-bureaucratic and very responsible way. I want to place on record my appreciation of their efforts.

It is very important that this House is seen to be responsive to the needs of people who have a grievance and want action. For many years members of ISANDS felt they were up against a brick wall and were making absolutely no progress. I commend the Minister and the Government for recognising that need at long last and for putting in place the legislative measure which will establish a stillbirths register. In many ways it was the decision to take the matter out of the Department of Health and put it into the Department of Equality and Law Reform which broke the logjam. If the matter had remained in the Department of Health I suspect that we would not be discussing this Bill. That point should be acknowledged.

I understand that the Department of Equality and Law Reform was established principally to try to meet the needs of the many groups in society who feel marginalised and who believe their grievances are not getting the ear of the people in power. Over the years there has been a breakdown in communication between groups in society and those in power. The Department of Equality and Law Reform can play a very useful role in dealing with many of these issues and breaking down bureaucratic logjams etc. This is why I so wholeheartedly welcome the establishment of a stillbirths register. I hope to see further examples of such progress in the years ahead.

As a result of this development, I have become a convert to the notion of a Department with specific responsibility for equality and law reform issues. I would be the first to admit that I was somewhat sceptical about the concept of such a Department when it was put forward at the time of the formation of the Government. However, from my experience of this issue, this Department has proven to be a very effective agent in expediting urgently needed legislation.

I support the fact that the effect of this Bill will be therapeutic and aims to respond to the needs of parents of stillborn babies. We must be careful with the compilation of statistical evidence in relation to stillbirth and any other defects relating to childbirth. People in the medical profession deal cautiously with such statistics. Obviously the mere existence now of a stillbirths register will have some significance in relation to the compilation of statistics. I accept the valid points made by Deputy McManus but we must examine that issue in a more uniform way from the State's point of view. We need to have a greater capacity to compile statistics, particularly in the health area. The Department of Health should become involved in this area because there is nothing worse than ignorance, misinformation and people being unsure about an issue. That generates a greater degree of anxiety. The compilation of statistics is important because it will help to allay fears in this area. However, in the context of this Bill, the motivation behind it was to give official recognition to stillborn babies. For many years the parents of stillborn children felt that their babies' short lives went unrecognised by many people but the most distressing factor was that they went unrecognised by the State.

The prime purpose of this Bill is to right a wrong that existed for many years. That is why the retrospective dimension of the Bill is so important; it makes some effort to undo the harm of neglect in this area for so many years. All those who campaigned for this register will also benefit from the enactment of the Bill and derive some satisfaction from the retrospective recognition that will be given to stillborn babies.

I, too, congratulate the Minister. The Bill is a compassionate one and his opening statement married a sense of compassion with the formality that is necessary for registration purposes and for the compilation of statistics. It is unfortunate that the legislation was not ready before Christmas to mark the tenth anniversary of ISANDS but no doubt the anniversary itself proved to be a major catalyst in pushing the legislation forward.

I mentioned earlier the whole issue of the democratic process responding to the demands of people. There are few Exchequer costs associated with this measure and there are virtually no staffing implications. We must all ask ourselves why this legislation was not brought forward earlier and we must remember there are other equally important issues requiring legislation that could also be brought forward quickly.

I do not intend repeating what other Members have said. I am delighted with the Bill, I congratulate the Minister on an historic breakthrough which will have implications for many people in this area and I wish him well in bringing forward further legislation in the years ahead.

Ms F. Fitzgerald

I wish to begin my contribution by congratulating the Minister and, indeed, his officials for introducing this legislation. However, it begs the question as to why it was not introduced earlier but if the Minister can market the mechanism he used to get this legislation through, there would be a great demand for it. It is quite extraordinary that the Minister has managed to bring forward this legislation despite the fact that the Minister initially — and other Ministers in the past — indicated they could not do this until an overall review of registration took place. The Minister has succeeded and, as has been said by everyone in the House today, sincere congratulations are due to him.

Of course, the Minister also has the appreciation of ISANDS who have campaigned for so long for this stillbirths register. I regret that they had to put so much time and energy into seeking to have this register established when it could have been done so much sooner. As Deputy Martin said, it raises questions about the responsiveness of the democratic process to the demands that are often made by lobbying groups outside this House. I hope the reforms that are underway in this House will ensure that we can be more responsive in future to issues such as this because the establishment of this register will bring great comfort and encouragement to parents of stillborn babies.

This register will help parents who, at a time of great crisis, feel isolated and lonely and it will give recognition to their baby, something which is very important to them. The fact that we are discussing this legislation is an indication of a greater understanding in dealing with matters relating to pregnancy and childbirth in this country. However, it is clear from the two recent cases involving abandoned babies that much work remains to be done, particularly in the area of education, before we can be satisfied that pregnant women receive the type of care, counselling, support services and information they need to help them cope and to give babies the best chance of survival.

I welcome the introduction of this legislation and the all-party support which the Minister is receiving is important. Before I was elected to the Dáil I lobbied, as chairperson of the Council for the Status of Women, for this legislation and I was part of a commission that also recommended such legislation. The people involved both on the commission and the council will be pleased with the introduction of this legislation.

I remember clearly when the first papers were published on this area, outlining what was happening to parents who experienced stillbirths and the hospital procedures which needed improvement. Great credit is due to the hospitals who responded quickly to that research information which highlighted that our hospital procedures and the way we were dealing with parents who had experienced stillbirths were inadequate. Indeed, there have been enormous improvements in this area on the part of the medical profession and hospitals generally and every effort is now being made to ensure that the trauma of stillbirths is reduced. The statistical information that will be gathered as a result of this Bill is important and I hope it will be put to good use. The Bill will encourage further research into this area.

A number of Deputies mentioned miscarriages. Although the Bill does not deal with this, it is important that we encourage research into the area of miscarriage. Miscarriage is very common and again is an isolating experience. At a time when medical technology has improved so much, parents are often surprised by the fact that they have had a miscarriage. If this Bill also encourages research into the area of miscarriage, it will prove helpful to many families in the country.

The statistical information already available to us in relation to stillbirths raises serious questions which need further examination. Once again they highlight the connection between social class, employment status and health and I agree fully with Deputy McManus — and I believe this was also highlighted in the Seanad debate — that we must continue to examine the impact of social and economic factors on the health of our people. There are very deep connections and we have not begun to address them sufficiently.

I also welcome the retrospective provisions in this Bill which will be very helpful to people who experienced difficulties and traumas in the past. Although I am sure parents never really get over the trauma of a stillbirth I hope this Bill will help to complete the process of grieving involved, as I am sure it will at least for some.

I am delighted the Minister has introduced the Bill and I congratulate the many agencies, particularly the Irish Stillbirth and Neonatal Death Society, on the amount of energy they invested in its production.

Mr. Ferris

With the permission of the House I should like to share my time with Deputy de Valera.

Like other Members, but particularly as a member of the Labour Party, I am pleased that we have this Bill before us and that its provisions will obtain in a very sensitive area, one which the Minister for Equality and Law Reform addressed with a certain amount of enthusiasm when the matter was brought to his attention. He has treated this matter with the compassion and sympathy appropriate to the post he holds in Government, particularly working from the base of equality. Deputy McManus felt the matter should have been dealt with by another Minister but, if ever there was inequality in any area, it was in this one in that to date we had refused to register stillbirths.

There had always been unanimity among political parties in both Houses on this issue. However, were it not for the commitment of the Government to follow that sentiment through with the necessary legislation, which does not cost very much, the position might well have remained unchanged. There was a need to point out that this matter should be addressed so that the Government would respond to the representations made to all of us by ISANDS. That society has been magnificent in its passion, as was the Council for the Status of Women and other agencies, who brought this matter to our attention over the years. They had a great input into the provisions of this Bill. Once the Government agreed to legislate in this area the Whips responded to ensure that this Bill would be dealt with adequately in the Seanad, where it was initiated, and could be debated beyond the hurly-burly of this Chamber where, as Deputy Quill said, we tend to be more involved in the cut and thrust of politics. Indeed, the moment the Seanad passed the Bill the party Whips agreed that, once it had been introduced in the Dáil, we would give it the priority it warranted. It was agreed to deal with it on one sitting day so that it could be signed by the President and take its rightful place on the Statute Book.

The Minister pointed out that six in every 1,000 births may be stillbirths and many Members, including myself, have family members who have been touched by the trauma associated with stillbirths. It is only when one is directly confronted with the attendant trauma one realises just how sensitive an area this is and one which needed to be addressed by our legislators. Very few traumas can compare with parents' grief on the death of a child. All too often we see the tragic loss of young life resulting from accident, illness, terrorism or war. Daily on our televisions screens we see pictures of children starving, dying or being killed. How can a person console those parents? There is very little anybody can say which would relieve their trauma or sadness. Neither can anybody answer the question these parents ask daily, why did this have to happen to them?

When children are sick, terminally ill, awaiting donation of various organs or whatever, they receive tremendous support. Parents whose children die while still in the womb grieve in an even deeper manner than other parents who have had the experience of having had a child with them for some period after birth. They mourn the children they never knew. It is a very sensitive area and I am glad we as legislators responded to the representations made.

To date the lack of appropriate legislation rendered parents' anguish all the greater because, in the case of stillborn babies, of the failure to acknowledge that that tiny person ever existed. Nobody was obliged to record their all too brief existence. Their parents were grief-striken, heart-broken but, as far as the law was concerned to date, nothing had ever happened. The law, in its silence, said there was no birth and no death. Recently staff in neonatal, gynaecological hospitals and maternity units realised the damage being done to parents in treating stillborn babies in this way. Many changes were effected to help comfort such families. Even the Roman Catholic Church responded by their ceremonies, celebrating a Mass of the Angels and by way of other sensitive responses, at least demonstrating sympathy to the parents concerned. For example, hospitals have been known to assist them in taking photographs, as Deputy Bradford said, which tend to be cherished forever by the parents. Hospitals handle such tragedies with compassion. I am glad such changes took place.

Many of the issues mentioned by other Members do not require legislation but rather should be handled by the Minister, with the authority to involve other ministries. I am referring to counselling and treatment after the event, particularly for mothers.

The underlying problem remained, the lack of a formal acknowledgment of stillborn births. Following the passing of this Bill it will be possible to register stillbirths.

The Minister is to be commended for introducing this Bill. The register comprises one strand of an overall review of the registration of births, marriages and deaths. I have been successful, not alone in having this Bill introduced — I have been engaged in this campaign since first elected — but also in initiating changes in the registration certificates, in the national registration authority. Up to the time of that change it was not possible to issue a certificate, even in the event of the first certificate being issued in error, without getting involved in an extraordinary amount of bureaucracy. I am glad there is now the possibility of having a proper registration and recognition of genuine errors made in the past. We must remember that many births were not registered, which is an offence. I am aware of Members' concerns in this area. From what was said in this debate it appears that other Members are concerned.

Following the enactment of this Bill a stillbirth certificate will be available to bereaved parents, lending formality and legal status to their loss. Indeed it will serve as a focus point for their memories of the dead child and help them come to terms with the attendant grief. I note that the register will not be open to public inspection. I agree that this data should be confidential to protect the families concerned. Legal provision is already in place to allow for the recording of fathers' names on registers even in the case of parents who were unmarried.

The Minister has identified a child weighing 500 grammes or more, or having a minimum gestation age of 24 weeks, who shows no sign of life at birth, to be classified as a stillbirth.

The Bill also gives parents an opportunity to notify the local registrar of the stillbirth if they choose to do so. If we are to have registration it must be obligatory and I am glad the Minister is placing the obligation on the hospital or the medical practitioner, possibly in consultation with the midwife, to register the stillbirth. The retrospective element in the Bill will give consolation to those who have been trying to get this legislation for the past decade in that they will now be able to have the stillbirth registered. This has been welcomed by ISANDS and the Minister is to be congratulated. He will be thanked by parents and by those who have experienced the trauma of a stillbirth. In the past we ignored the life that ended in the womb. I am pleased that the Government responded to our requests in this sensitive area.

Miss de Valera

I thank Deputy Ferris for being kind enough to share his time with me. I welcome this Bill as it will help many to come to terms with their grief, not just the mother but the father and siblings. I take this opportunity, like other Members, to congratulate ISANDS and all those who, over the past decade, had a tough time campaigning to bring the stillbirths register into being.

Many studies have been compiled on this issue, not least one by Therese Brady et al which found that a mother's reactions to a stillbirth were consistent with the recognised stages of the grieving process — numbness, anger, futility, guilt, blame, sadness and even a sense of failure. This study identified, as did many subsequent ones, a number of practices which ignored the reality of the loss and which the women perceived as a failure to accord to them the status of a mother and to their stillborn the status of a real baby. Some mothers even felt a sense of shame due to the apparent lack of importance attached to their loss. In some ways it was as if their loss was disregarded.

Support at such a time from relatives and friends is vital for both parents and siblings. The lack of such support has been shown to exacerbate the impact of stress. Through the Bill, the State can help to alleviate some of the grief for the family involved by the formal recognition and confirmation of the existence of the stillborn through compulsory certification. This was one of the recommendations of the study by Therese Brady et al.

The stillbirths register will give tangible acknowledgment and identity to the stillborn. The State will no longer fail to recognise the existence of the stillborn, which has compounded the grief of mothers and families who have suffered such a loss.

It is acknowledged that there are a number of areas in the management of stillbirths. These include the level of communication between hospital staff and the parents, sensitivity to parents' needs, the involvement of both parents together in a total experience and the nature of the burial arrangements. The tangible recognition of the stillbirth by registration is concrete and practical. I am glad that the Bill will put this into immediate effect. My only regret is that this Bill did not come to fruition many years ago. Most, if not all, the EU countries have such a register.

No doubt there will be much discussion about the definition of a stillbirth and whether the medical and legal definition would be in conflict. I hope the definition will be as wide and inclusive as possible. In common with other Deputies I welcome the Minister's proposals in this regard because I understand he has been as flexible as possible.

I commend the fact that retrospective registration on a voluntary basis is provided for in the Bill. Many psychologists and psychiatrists could tell the House that there have been cases where the stillbirth took place more than 30 years ago and yet that deep anxiety, sense of loss and real grief has still to be worked out. This underlines the mother's and the family's sense of expectation turning to a total sense of emptiness and loss. I am pleased to note that the retrospective provision has no antecedent time limit.

This registration will not only be a focus for the memory of the bereaved but will also encourage research into stillbirth and the causes of miscarriage. Such statistical information is essential for research. Such research need not just be of assistance in the world of medicine. As legislators, we should note that the stillbirth rate among unemployed and unskilled manual workers is much higher than that among professional or salaried employees. I hope the Minister, following on from this Bill, can ensure adequate counselling through the health boards or in other ways to deal with the very real experience of grief for parents and siblings.

I welcome and wholeheartedly support the principle of the Bill which will have cross-party support. I look forward to its early implementation and congratulate the Minister for dealing expeditiously with this very serious and sensitive matter.

Mr. Flanagan

I extend the congratulations of this side of the House to the Minister for acting on this matter. I wish to share the time available to me with Deputy Doyle.

I welcome this legislation which has been promised for some time. I am delighted the Minister when bringing forward the legislation decided not to do so in the context of an overall review of the legislation pertaining to births, deaths and marriages which, I understand, is at present in the course of preparation in his Department. I welcome the fact that he isolated this legislation and was able to proceed with it because of the importance of dealing with the matter at the earliest opportunity. Over the past ten years people have been lobbying successive Ministers for Health on the importance of a change in legislation. It is regrettable that in the course of that time we have had almost 4,000 stillborn babies.

We are talking about a measure of relief and comfort that will be available to parents following the emotional trauma of a stillbirth. It is important that accurate statistics be available. The statistics of less than 300 stillborn babies on an annual basis may not be accurate. The fact that this register will be available to the Department will be of enormous importance from a research point of view in so far as it will enable various studies to take place against a background of accurate information. This is extremely important when dealing with clusters of stillbirths and malformed babies which we have been hearing so much about in recent days. Although this legislation has been introduced by the Minister for Equality and Law Reform, Deputy Taylor, close contact should be maintained with the Department of Health. If we are to identify parts of the country where there is a higher than average number of stillborn or deformed babies, it is important that the statistical information be available. The register will help in many respects. The memory of the event for parents of stillborn babies is extremely important. Reference has already been made to that aspect by other speakers.

It is for the Minister for Health, Deputy Howlin, to deal with the extraordinary fact that, although Ireland is the safest country in Europe and among the safest in the world to have a baby, nevertheless the stark reality remains that so far as perinatal deaths are concerned we rank third highest in the European Union. I do not know why that is the case. I do not know why, in the course of the first week of infancy, more babies die in this country than the European average. I hope the Department of Health can ensure that research is carried out to identify the reason. We must look at the maternity services and see what improvements can be made to ensure that our figures are accurate and that there is no neglect.

It is important not to ignore the whole area of miscarriage. I realise it is not relevant to this legislation but the next step must be to develop a register of miscarriages. While there may be up to 300 stillborn babies annually, the number of miscarriages must be tens of thousands. I doubt whether there is any statistical information on the numbers involved. If we were to have a register for miscarriages it could be of great assistance to the development of research.

While the provisions of the Bill provide for a register of stillbirths the back-up counselling services are of tremendous importance. I regret that when replying to this debate the Minister for Equality and Law Reform, Deputy Taylor, will not be in a position to advise as to the level of counselling services as they are not within the domain of his Department. I stress the need for communication and liaison between the Minister's Department and the Department of Health. The availability of a counselling service in each health board area is extremely important. There is no point in having this register unless it is accompanied by an appropriate counselling service provided by the State.

The Irish Stillbirth and Neonatal Death Society is the group which prompted the legislation before the House today. I am delighted we have changed the emphasis in the way we treat stillborn babies. Until recently, in many instances, the mother never saw the baby. Parents had absolutely no say in the disposal of the remains of the baby. I am delighted that has changed.

It is important that separate hospital accommodation be provided for mothers in hospital at the time of a stillbirth or miscarriage. This is a time of tremendous trauma and anxiety. A modicum of comfort and private accommodation should be available. The provisions of the Bill allow for the issue of a certificate which will provide a lasting recognition.

I should like to refer to one point in the Bill to which I hope the Minister will refer in his reply. There is no reference to a midwife in section 6, which deals with the notification and registration of stillbirths occurring after the commencement date. Why does the legislation require the medical certificate to be signed by a registered practitioner? What is the role of the midwife in all of this? Would it not be acceptable that the registration take place and be witnessed by a registered midwife? During recent years there has been a downgrading by the State, the Department of Health and the health services, of the position of the midwife in the community. That is wrong. It is regrettable that we have not encouraged our midwifery services so as to allow the midwife play a greater role.

We have reached a stage where pregnancy is regarded as a medical condition and doctors have to be involved at all stages. Pregnancy is a natural condition and should not be regarded as an illness. This unnecessary involvement of the medical profession is continued in this legislation where the Minister requires a registered medical practitioner to be involved rather than a midwife who might do the job better. I would welcome the Minister's views on that point.

I pay tribute to the committee members and the many committed members of the ISANDS group who, I am sure, are delighted with the Minister's action following ten years of continuous campaigning on a matter that is of extreme importance to them. It is noteworthy that this legislation is welcomed by every Member of every party in this House.

Mrs. Doyle

I thank Deputy Flanagan for sharing his time with me. My function is not to repeat what has been said on one of the few Bills on which there will be no conflict in this House and that is as it should be. On behalf of Wexford ISANDS I thank the Government and the Minister for bringing to a conclusion a ten-year quest for a stillbirths register. It is hard for many of us to appreciate how important this Bill, small in terms of the panoply of legislation with which we have to deal, is for parents and families who have been through the trauma of a stillbirth.

The Wexford group was formed only last September having been encouraged by the matron and nurses of Wexford General Hospital to give support to and share experiences with parents who had been through this trauma. I thank Jean Wafer, Mary Delaney, Catherine Howard, Brenda Murphy, Margaret Dempsey, Eileen Hughes, Kathy White and all the active members of Wexford's ISANDS. I know what they did in Wexford reflects what other groups have done throughout the country to ensure that the message was heard and understood by the Minister so that legislation could be brought forward quickly, without further delay.

Like other speakers I thank national ISANDS and individuals who communicated with Deputies to keep the problem to the forefront. Deputies desks are piled with various problems but there was a concerted campaign which was always kept at a level which did justice to the cause, to keep the problem to the forefront. Deputies, both men and women whether married or single, or whether they had contact with people who had been through this trauma, understood exactly where ISANDS were coming from. I pay tribute to them for the level on which they conducted the campaign which has been most effective. I also thank the Minister for his rapid response. I also thank hospital chaplains, midwives, nurses and people who throughout the country kept pushing this cause in the right direction.

The chaplain from Wexford General Hospital wrote to me last October to make me aware of his support for a stillbirths register and pointed out than an important aspect of his work as chaplain was to comfort parents grieving the sudden loss of an infant. He pointed out how precious were the few memories of the child and said that he felt that a stillbirths register would provide parents with a lasting memory of their child. He pointed out that we must realise the very real hopes and aspirations these parents had for their children which had been cruelly dashed and that no amount of words could explain the importance of a certificate in the hands of a bereaved mother or father as the years go by. In a few simple sentences Father Browne and all the others who contacted us explained the need for the stillbirths register.

I will not parse and analyse the Bill before me. Other Deputies have questioned legal and medical definitions to make sure that this will not be a lawyer's charter down the line to keep people busy fighting technical issues. I trust the Minister's experience in that area to ensure that Deputies doubts are erased before Committee and Report Stages.

The ISANDS campaign is an example to other groups of how to achieve an end and how to make a case to keep it in the public eye and in front of politicians. Would that many other pressure groups would learn how so much can be achieved by tackling a case properly. I thank those at the head of national ISANDS as well as the constituency groups for the way they conducted their campaign and for their achievement. That group more than any other can, perhaps, really understand what it means to have a stillbirths register and legal acceptance of the child that has been lost. Another point made to me is that the change in the gestation period in terms of recognising a stillbirth is extremely welcome and I also thank the Minister for that.

Most of what needs to be said has been said but it would be remiss of me not to thank the Minister on behalf of the Wexford branch of ISANDS and on behalf of my constituents, many of whom still perhaps do not know of the existence of ISANDS but who have been through this traumatic experience. Most of us will never understand what this Bill will mean to parents who have suffered this trauma.

Mr. D. Wallace

I propose to share my time with Deputy Pat Gallagher. Like previous speakers, I am pleased to have an opportunity to contribute to this debate. I, too, pay tribute to ISANDS for their commitment and dedication over many years in support of the families who have experienced stillbirth.

My first experience in this area was a number of years ago when Father Frank Buckley, the chaplain to families of stillborn children in Cork came to me about the need for facilities at St. Finbar's Cemetery in Cork. I was glad that the city manager and Cork Corporation acted positively on that occasion and today a suitable part of the cemetery is set aside for stillborn children.

I pay tribute to the members of Cork ISANDS for their commitment and dedication. They are here today for this occasion which is very special to them. The passage of this Bill shows that minority groups are catered for and that we do not care only about the large vote catching issues. I compliment the Minister on bringing forward this long overdue legislation.

I welcome the proposal for the formal registration of stillborn infants. The Bill has been drafted in a sensitive manner to give recognition to the infant while at the same time minimising the level of intrusion into the family at a time of great loss and grief. Not surprisingly we tend to avoid the subject of death as much as possible as it brings to mind the loss of loved family members, friends and members of the community. It also reminds us of our mortality. Whether we like it or not we are likely to have to cope with the death of a family member or a close friend during our lifetimes.

One must go through various stages of reaction and grief following the death of a loved one and there are various ways to make bereavement more bearable. We need the support and sympathy of others and we have happy memories of shared time and experiences and the healing power of time. Without such consolations it can be extremely difficult to recover from bereavement. The family trying to cope with the loss of a stillborn infant must deal with all the emotions experienced from other deaths but they have two further obstacles to overcome. After all the months of happy expectation they must suddenly adjust to the fact that the infant has been lost. Once the family have begun to deal with their grief a second problem often emerges. It can be devastating for a family that their infant should be without formal identity because of the nature of death. While this problem may not be acute in the period immediately after the loss, it can grow with time and become a source of great distress to the parents. There is simply no record that the infant ever existed. The primary intention of the Bill is to allow for official acknowledgment of the infant. Ultimately the responsibility for the task of registering the birth lies with the relevant medical personnel, though the parents may register the stillbirth if they wish. The facility that allows for retrospective registration is very welcome.

This Bill poses a challenge to every one of us. The Bill provides a procedure through which stillborn infants are rightfully acknowledged and their identity confirmed. This will provide some degree of support to bereaved families. However, I believe that society in general needs to become far more sensitive to the special needs of such families. There is a lack of ritual in the case of stillbirths and the community may not have a formal opportunity to express their support for the bereaved family. As a result many people may find it difficult to communicate their deep sympathy to the bereaved friends and consequently a breach may develop. The family may mistake the lack of communication for a certain degree of indifference or uncaring but for their part friends may feel frustrated at their inability to find an appropriate way to express solidarity with the infant's bereaved family. A stillbirth causes the same degree of distress as the loss of an infant in the early stages of life. The pain is as acute and the need for care and support is equal.

We need to heighten awareness of the special needs of the bereaved. This needs to be dealt with during a person's formal education. Young adults should be made aware of the reality of stillbirth when pursuing subjects such as civics, and social and scientific studies. Because of the central role of the medical and nursing professions during the pregnancy and particularly at birth, it is especially important that the intensity of grief associated with stillbirths should be fully acknowledged in the formal training of doctors and nurses. Full provision must also be made to ensure that specialist counselling support is available to the bereaved families as required. ISANDS continues to do a tremendous job with the families with whom it is involved.

The Minister and his staff have shown great sensitivity in drafting this Bill and I hope it will remove one cause of heart-ache for affected families. The contributions to the debate have been wide ranging but I have attempted to deal with the main points instead of the medicolegal area. This is a good day's work and certainly it is a very good day for ISANDS. I strongly support this Bill.

Mr. Gallagher

(Laoighis-Offaly): Ar dtús ba mhaith liom buíochas a ghabháil leis an Teachta Dan Wallace as ucht a chuid ama a roinnt liom.

I compliment the Minister on introducing this Bill in the Seanad and also on the sensitive and sensible approach to the drafting of the Bill demonstrated in his opening speech.

It is worth bearing in mind that there are 300 stillbirths each year. That is a significant number and each one is as important as any other case of birth or death. The Bill before us today gives practical effect to the oft quoted adage that all the children of the nation shall be treated equally. I wholeheartedly support this Bill.

The Minister said that the grief and trauma suffered by affected families was exacerbated by the lack of official recognition. I am delighted that our law is coming into line with changes in understanding and practices in the area of stillbirth. Greater recognition and sensitivity is shown to the needs of parents who experience a stillbirth by the medical profession and the Church. I join with other speakers in paying a wholehearted tribute to ISANDS for its diligent work over many years. I also wish to acknowledge the effort of many individuals who live in areas where ISANDS is not organised but who have quietly made people like me aware of the need to change the law in this area. I am sure this will be a day of satisfaction to them.

The introduction of this Bill proves beyond doubt the importance of the Department of Equality and Law Reform. Many commentators questioned the necessity of establishing such a Department but it is evident that many changes affecting what might be termed as small groups in society were left in abeyance. It was also important to separate the civil and criminal law reform functions of the Government and to promote equality, a task which had been neglected by successive Governments. I thank the Minister for taking this on board, together with the other Bills he has brought before the House.

I will take this opportunity to outline the examples of the sensitivity shown in the Minister's approach. He has stressed that this Bill is very much a therapeutic measure for the parents of stillborn children and a means of alleviating the grief of parents. I welcome the emphasis he has placed on the process of registration which he stressed should not be overly bureaucratic and that sensitivity will be shown to parents. At the same time, however, the Minister has stressed that this is an official register. The registration of these children will have the same legal standing as the registration of any other child and this is very important for the parents concerned, particularly in subsequent years. I welcome the fact that he has accepted a very wide definition of stillbirth. In his opening address he said that some countries in the European Union relate it to gestational age whereas others relate it to the birth weight. It is right that he has taken both approaches. I welcome the fact he has decided the definition should cover both and I am sure it will be applied with the utmost sensitivity.

I also welcome the fact that stillbirths will be registred, as in the case of births or deaths, at local offices; in other words, no special procedures will have to be followed. This is important. I am sure the staff in those offices will show the necessary degree of compassion and understanding in registering these births. While it is important that registration be compulsory it is wise to allow stillbirths be registered in a number of ways. For example, this can be done by the parents, the medical practitioner or the relevant hospital.

I am pleased that there is provision for retrospective registration. It is often the case that there is a difficulty with the concept of retrospection but I am sure that will not be the position on this occasion. As the Minister said, in the absence of retrospection this Bill would come too late for many parents. I am glad that those parents who suffered the trauma of a stillbirth when people were less sensitve will now have an opportunity to have that birth registered by the State.

Registration should remain a private affair between the parents and the registrar and the personal details on the certificate should be in line with the recommendation of the Second Commission on the Status of Women.

The Minister and his officials, in conjunction with other Government Departments, particularly the Department of Health, following the passing of this Bill should examine how information on this much needed change in the law can be disseminated in a sensitive but effective way. The organisation, ISANDS, the hospitals, their staff, hospital chaplains and the health boards would be willing to play their part.

Ms Keogh

I, too, wish to congratulate the Minister — we rarely do this — on introducing this long awaited legislation. I also congratulate the members of the Irish Stillbirth and Neonatal Death Society who have worked long and hard and who must be glad to see this legislation being put through the Houses of the Oireachtas.

Speaking as a mother, I have never suffered the trauma these parents experienced; I have experienced the joy of having children. I realise all too well the trauma suffered on the death of a child. However, one finds that people tend to minimise the trauma experienced by the parents of a stillborn child: it is a most distressing time. What made it even more distressing was the fact that it was not recognised. My primary concern is to acknowledge that at last parents will be able to have a stillbirth registered.

I hope that those who find themselves in this sad position will be able to avail of counselling services as recommended by the Second Commission on the Status of Women. I am glad the Minister has followed its lead and given this issue priority. I commend Members for their support of the Bill. I hope the Minister will follow up many other aspects of the commission's report quickly.

I am anxious that this legislation passes through the House and I am happy that I was given an opportunity to welcome it. It will be a great source of comfort for many mothers and fathers who have experienced this trauma.

Mr. M. Ahern

I join with other Members in welcoming this long overdue Bill. No parent forgets the experience of a stillbirth. There is nothing more traumatic for parents, particularly the mother who has borne a child to full term, to find that it has been born dead. Parents will never forget a child who dies before they get an opportunity to get to know him or her. Each individual will have to find their own way of coming to terms with this great loss but it is also important that there be recognition by the State of the person who has died. As Members are aware, there was no register up to now.

The Church authorities have been a source of great help and comfort for parents of a stillborn child by their participation in the burial rites and the provision of general advice. I hope the State services will be expanded to help parents when a child is born dead.

The rationale for the proposed register is essentially therapeutic. While it is not necessary to have a name inserted in a register to ensure that a child is remembered it is important that it is recognised in law, particularly for the younger members of a family. It is nice to think that they will be able to see the birth certificate of a brother or sister who was stillborn.

I commend ISANDS for the work it has done during the years. I am glad that this issue is being brought to a successful conclusion today. I applaud the Minister for introducing this legislation quickly and hope that we will see further improvements in this area. As we are aware, the Minister has given a commitment to improve services for those in need.

I hope the Bill will go through and be signed as quickly as possible by the President. I am especially delighted to see a provision for registering stillbirths which took place prior to the introduction of the Bill, because it gives those parents who have had stillborn children in the last ten, 15 or 20 years an opportunity to have their children registered. That is an unusual provision in a Bill but it is a compassionate and considerate approach and I commend the Minister for including that section.

Mr. Flood

I would like to be associated with the remarks of previous speakers congratulating the Minister, Deputy Taylor for bringing forward this very important and caring social legislation. We must ask ourselves why it has taken so long in view of the campaign that has been waged over the past ten years to bring in what is essentially simple legislation; and how we might expedite the introduction of legislation that is sought by sections of our community, is not controversial and, generally speaking, is supported by the vast majority of Deputies. We might well deal with other legislation which, although important only to a small number of people, is neverthelsss capable of being brought before the House and being passed into legislation without much delay. It is an example to allow us that in the short time Minister Taylor has been in office he has managed to bring this important legislation to a number of people who were, perhaps, feeling somewhat left behind.

In the short time that I was in the Department of Health, with some responsibility for child welfare, I was turning my attention to this issue. I was personally disappointed to find that it was not high on the list of legislative priorities within the Department. I was hoping to become personally involved in bringing it forward as quickly as possible in view of the representations I had received from colleagues in this House and representatives of the various associations which have been referred to during the debate.

There are about 300 stillbirths in this country every year, each representing great personal loss and tragedy not only for the mother and father but also the extended families. Unfortunately these have, to a large extent, gone unrecorded with no opportunity for people affected by such tragedies to record the permanency of the fact that a stillbirth took place. This legislation meets the objective of parents, extended families and communities affected by such tragedies who can now have an official record of such stillbirth.

Bearing in mind that most other European Union countries have a stillbirth register already in place, I am disappointed that we have delayed so long in meeting the legitimate requirements of those in our society affected by stillbirths. We should bear that in mind in relation to other areas where legislation may have a beneficial effect on those directly affected, even though they are numerically small. That certainly should not be the cause of leaving certain legislation on the sideline.

Minister Taylor also referred to the therapeutic effect of the legislation. I agree with that approach and also with the views expressed by contributors to the debate not just in the Houses of the Oireachtas but in the community generally about the necessity for making professional help and advice more readily available to those directly affected by stillbirths. Our health service has not been structured to meet needs which often arise at short notice and are very intense for a short period. I hope the Minister for Health will try to improve such facilities for people who need them.

I want to touch briefly on some sections of the legislation. I understand the Minister is adopting the World Health Organisation's position in regard to the definition of a stillborn child. That is fair enough; one has to have certain parameters. However, complications may arise because there will always be the possibility of the weight not being achieved or the gestation period of 24 weeks not being reached and a parent or parents may be aggrieved at not being able to have the birth defined as a stillbirth and have the registration process take place. Would it be possible to vary that section to allow the views of the parent or parents to be taken into account, because this will not in any way affect society or the community? It is important to parents to have a stillbirth defined as such and have it registered. I know the Minister will try to take account of this, notwithstanding the difficulties.

In section 6, the Minister is not compelling parents to register a stillbirth but is compelling hospitals and medical practitioners to do so. There may well be occasions when a parent or parents decide that they wish this matter to be private within their own family and do not wish a registration to take place. I am not saying that will happen, but the possibility is there and it might be appropriate, because of the caring social approach of this legislation to take account of this fact in it. Not every parent may wish to have a stillbirth registered. If that is not the case, I accept that section 6 should not be altered. I acccept that the compulsion gives it a certain statutory strength. I just wonder can the legislation be modified to take account of the wishes of parents who do not wish a registration to take place. That may have wider implications for the strength and vigour of the legislation. If it does, I certainly accept that section 6 should remain unaltered.

I am glad to see that under section 8 the register will not be accessible to the public. Currently, one can obtain a copy of a birth or death certificate on payment of a fee. Stillbirths are very personal to the parent or parents and the immediate family. Therefore, I am glad to see that any member of the public cannot simply wander in, pay a fee, and obtain a copy of the certificate concerned.

This is part of the Minister's wider brief in equality and law reform. Bearing in mind his record to date, if this is an indication of how he intends to proceed in the area of equality and law reform, the future augurs well for dealing with a number of major issues which are likely to arise in the lifetime of this Government. The Minister has an important date with the people later in the year, when other important matters will be dealt with. The decision of this Government when taking up office to put in place a Department, which at the time may have been criticised, has proved beneficial. The Minister's Department is the engine of law and social reform here and I hope that at the end of the lifetime of this Government the Minister, Deputy Taylor, will have achieved a great deal in bringing forward necessary long overdue legislation which, in many cases, affects a large number of people.

Dr. Moffatt

I welcome the legislation and compliment the Minister on introducing it. It has been requested by parents, members of the medical profession, members of ISANDS and others for some time. The Minister tried to satisfy everybody by giving a broad definition of the word "stillbirth", namely, a foetus born dead at a gestational age of 24 weeks or more or weighing 500 grammes or more. Some may quibble with that definition and prefer the one used by the World Health Organisation, but I am satisfied with the definition in the Bill. I also welcome the provision in regard to retrospective registration.

This legislation is important from a number of viewpoints, for example, the therapeutic parental aspect, the statistical aspect and the fact that it brings us into line with other EU countries in regard to legislation on stillbirths. From an obstetrical point of view, the legislation will highlight recent advances in perintology and neonatology especially having regard to the viability of foetuses from the gestational period of 24 weeks or more. The recent remarks by Dr. Mortimer of Galway University College Hospital about the possible linkage of stillbirths to the sudden infant death syndrome should be noted. A stillbirth certificate and a photograph of a stillborn baby will help parents, families and relatives in their time of grief. Great strides have been made by nurses, doctors and the religious to assist parents during the grieving process.

From a statistical point of view, it is important for medical and sociological researchers to ascertain the total number of stillbirths per annum and if there are any aetiological factors present. In the majority of cases the cause may not be ascertainable, but many factors were alluded to this morning, for example, the rhesus haemolytic disease, preventable anoxia, folic acid deficiency which has been associated with neural tube defects and perhaps an encephaly. Environmental factors, especially radiation, were also alluded to and, in that regard, particular reference was made to County Louth and the investigations carried out there by Dr. Sheehan. Deputy McManus also mentioned some sociological and economic factors.

Recent advances in obstetrics, that of ultrasound, placental biopsy, amniocentesis, blood gas analyses and genetic screening may also prove helpful in elucidating the causative factors in stillbirths. The recent finding of Dr. Mortimer in UCG hospital of the possibility of an association aethiologically between stillbirth and the sudden infant death syndrome should be noted. He has carried out research in that area for the past 20 years and I hope worthwhile results will be forthcoming in the near future. Nevertheless, that is a ray of hope from an aetiological point of view in respect of stillbirths and sudden infant death syndrome.

In general, Irish families have become smaller and information on stillbirths is crucial to parents, obstetricians, the nursing profession and so on. The recognition given to stillbirths in this legislation will go some way in helping parents to deal with the tragedy of a stillbirth. I thank ISANDS for highlighting the issue.

Mrs. Owen

I want to add my voice to the debate on this legislation which has universal agreement from all sides of the House. I compliment the Minister on doing a very good job and we in Opposition are always willing to acknowledge that.

It is important to note that this legislation was introduced following a ten-year campaign by those who suffered the trauma of stillbirth. I compliment them on their persistence and resilience in the matter. Many speakers referred to the trauma and effects of a stillbirth on a family. Female Members of the House who have had children can empathise with the trauma of childbirth, in particular, the birth of a child that is already dead. It is difficult enough to have a child that is born alive but giving birth to a stillborn baby is much more traumatic.

ISANDS campaigned for the setting up of a register of stillbirths which will give a certain dignity to the parents involved. Many parents of stillborn babies have told me that the sense of isolation and loss is similar to that suffered by the parents of a child who dies at a young age. Up to now, the attitude of society was that a stillborn child did not exist, in other words, it should be a forgotten period in the lives of the parents. I am glad that such parents persisted in their campaign and I am sure the Minister is well aware of their trauma. I welcome the provisions in the Bill regarding the availability of a register and the many other issues to which Members referred. Deputy McManus has tabled some amendments which we will deal with on Committee Stage.

It is important that we do not segregate people who have gone through the trauma of stillbirth into a certain class. Therefore, the provisions of the legislation must be, as far as possible, similar to those which apply following the death of a human being. In that respect the Minister has included a provision in regard to a compulsory register for the certification of stillborn babies, amending the Birth and Deaths Registration Act, 1863.

Siblings of stillborn children must also be considered. They may be teenagers or young children at the time of the stillbirth and would have a sense of family and understanding of the trauma their parents have suffered, particularly their mother. The registration proposed in the Bill will assist in recognising the trauma which families experience and will help teenage or younger children to understand they had a brother or sister who did not survive full term in the womb or was born dead. They too can share in the grieving and loving process which they would have had for the child had he or she lived.

I was impressed by Deputy de Valera's contribution, which I heard outside the Chamber. This issue has been raised by the chairperson of the Joint Committee on Women's Rights, Deputy Theresa Ahearn, and other Members. Deputy Bradford has highlighted this issue for a number of years. This unites the humanity of Members of the House. We have awaited it for a long time. I commend the Minister for introducing this Bill and, indeed, this type of legislation which has been outstanding on the Statute Book for many years. I hope the Minister will continue to make necessary changes as quickly as possible so that people can live their lives in dignity.

Minister for Equality and Law Reform (Mr. Taylor)

I thank Deputies for their constructive and sympathetic response to the Bill and their kind remarks. The concern of Deputies who spoke on this Bill this morning is not one that arose today or yesterday. Since my appointment I have received representations and am in consultation with Deputies on all sides of the House in regard to this issue. That indicates the finest tribute to the democratic traditions of our society. Like other Deputies, I pay tribute to ISANDS, both at national and local level. I have met many local groups. They have always been most helpful and constructive in the ongoing consultations my Department and I have had with them. As a result of that participation we have produced the type of legislation which meets the wishes of Members on all sides of the House.

The Bill is introduced primarily to afford comfort to the bereaved parents. A stillbirth is an event which has a profound impact on all those involved. Since my Department assumed responsibility for this area I have spoken to many parents of stillborn children. They told me of their strong feelings of grief and loneliness following the stillbirth. They emphasised the importance of official acknowledgment of the stillbirth. They consider that the absence of official validation devalues the significance of the stillbirth.

The question of my constituency colleague, Deputy Flood, regarding whether the registration should be compulsory or voluntary was the subject of the intense discussion with ISANDS and within my Department. It was decided that registration must be compulsory to underscore the official character, the status of the register and emphasise the tangible nature of the stillbirth. The registration procedure is in line with that which applies to the registration of live births. I am sympathetic to Deputy Flood's question regarding the privacy some families may require at such a time. The information on the register will not be open to public scrutiny. The stillbirth must be registered, but the privacy of the parents is safeguarded by the introduction of the provision that it will not be open for public inspection.

Some speakers referred to the possibility of registering miscarriages. A stillborn child is a child born dead who has reached viability outside the womb. A miscarriage takes place before the child is capable of being born alive. There is an important difference, which is recognised both medically and legally. It is standard international practice to draw a line between a stillbirth which is registerable and a miscarriage which is not.

The campaign for the registration of stillbirths has been ongoing for many years. I am glad to have been associated with this measure which will give the bereaved parents the official recognition they have sought. Under section 13 (3) the Act will come into effect by order on a specified date. While it will take some time to put in place the administrative arrangements for the implementation of the Act, I intend to bring it into force at the earliest possible date.

Deputies referred to counselling and other important issues which they acknowledged are the responsibility of the Minister for Health. I assure Members I will bring all those issues to his attention and I am sure he will take the necessary steps within his power to deal effectively with those issues.

Deputies raised the question of the World Health Organisation's gestational age definition. There will always be borderline cases and so on. Ideally one would wish to be in the position to alter those criteria as time passes, taking account of developments in medical science by the simple procedure of ministerial order. Unfortunately, I was advised that such an alternation in a matter of substantive law would not be appropriate to secondary legislation and would have to be the subject of an amendment of the Act in due course. The constitutionality of deciding that matter by ministerial order would not be appropriate and I must accept that advice. However, I assure the House that as and when developments take place and if it is considered appropriate to amend that provision, I will have no hesitation in doing so.

I thank Members for their courteous and sensitive contributions and look forward to teasing out issues which arise on Committee Stage.

Question put and agreed to.